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23 views3 pages

Form Application New

Uploaded by

abaina
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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LADOKE AKINTOLA UNIVERSITY OF TECHNOLOGY,

P. M. B 4000, OGBOMOSO, OYO STATE.


POSTGRADUATE APPLICATION FORM Affix recent passport
photograph here.
PGD, MBA, MEHM, MIT, MPA, MSTM, MTM
PERSONAL INFORMATION
Note: This form should be filled and returned with authentic copies of previous educational documents.

1. Surname:

2. First name:

3. Middle name/Third name:

4. Marital status: 5. Sex:

6. Date of Birth: 7. Email Address:

8. Phone Number: 9. Nationality:

10. State of Origin: 11. Local Government:

112. Home Town: 13. Religion:

14. Contact Address:

15. Mailing Address:

16. Name of Next of Kin:

17. Address of Next of Kin: 18. Phone number of Next of Kin:

19. Preferred programme (Degree/Diploma in view):

20. Dept.: 21. Faculty:

22. Field of interest:

FOR OFFICIAL USE ONLY


Result of application Signed Date

Result of communication Signed Date


1
Schools and Universities attended with dates
Name of school Town Country Years attended
From To

Degrees, Diplomas or Certificate (Class of degree and major subject must be stated)
Degrees Year Subject/course Class of degree

Distinctions and Prizes

List of Appointment in the Past five (5) years


Post Employer Period
From To

Publications and the title of thesis, dissertation or essay submitted for any degree
Publication Title Status Year

2
Other Details
Are you currently registered for a
degree in any University? Name and Address of Institution:

Course Registered: Degree in view: Date of first Registration:


Have you ever Applied for Year of Application Mode of study: Full time or Part time
admission to Postgraduate Studies at
this University?
Are you a graduate from this Matric no:
University
Name three persons to whom reference may be made
Referee 1
Name:

Position /Rank

Email/Mobile Number (must be valid)

Referee 2
Name:

Position/Rank

Email/Mobile Number (must be valid)

Referee 3
Name:

Position/Rank

Email/Mobile Number (must be valid)

DECLARATION BY APPLICANT:

I hereby declare that the information given above is true to my best knowledge and belief.

Signature: Date

FOR FURTHER INFORMATION, CONTACT: EKPO, I. AKANINYENE.


Mobile number: 08020500187 and/or 08034742530 OR
Email: [email protected] and/or [email protected]
3

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